Gouverneur Hospital
77 West Barney Street, Gouverneur, NY · Rochesterregional · · NPI 1629409925
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Inj. pemetrexed, 10 mg HCPCS J9304 | not published | not published | $46.35 – $97.88 | 2 |
| Inj pemetrexed (accord) 10mg HCPCS J9296 | not published | not published | $9.74 – $9.74 | 1 |
| Inj, pemetrexed (avyxa) 10mg HCPCS J9292 | not published | not published | $75.84 – $75.84 | 1 |
| Inj pemetrexed (bluepoint) HCPCS J9322 | not published | not published | $9.22 – $9.22 | 1 |
| Inj pemetrexed ditromethamin HCPCS J9323 | not published | not published | $10.34 – $10.34 | 1 |
| Inj pemetrexed, hospira 10mg HCPCS J9294 | not published | not published | $3.86 – $3.86 | 1 |
| Inj pemetrexed (sandoz) 10mg HCPCS J9297 | not published | not published | $1.74 – $1.74 | 1 |
| Inj pemetrexed (teva) 10mg HCPCS J9314 | not published | not published | $8.37 – $8.37 | 1 |
| Inj, pemrydi rtu, 10 mg HCPCS J9324 | not published | not published | $81.06 – $81.06 | 1 |
| Inj perflexane lip micros,ml HCPCS Q9955 | not published | not published | $12.96 – $12.96 | 1 |
| Inj., perseris, 0.5 mg HCPCS J2798 | not published | not published | $12.15 – $13.20 | 2 |
| Inj plasminogen tvmh 1mg HCPCS J2998 | not published | not published | $31.67 – $36.00 | 2 |
| Inj., plazomicin, 5 mg HCPCS J0291 | not published | not published | $3.57 – $3.97 | 2 |
| Inj pozelimab-bbfg, 1 mg HCPCS J9376 | not published | not published | $83.08 – $83.08 | 1 |
| Inj proc ankle arthr CPT 27648 | $256.15 | $394.08 | not published | 0 |
| Inj proc elbow arthro CPT 24220 | $98.72 | $151.88 | not published | 0 |
| Inj proc myelogram lumbar CPT 62284 | $462.54 | $711.60 | not published | 0 |
| Inj progesterone per 50 mg HCPCS J2675 | not published | not published | $0.66 – $3.75 | 2 |
| Inj prohance multipack HCPCS A9576 | not published | not published | $3.86 – $3.86 | 1 |
| Inj protirelin per 250 mcg HCPCS J2725 | not published | not published | $20.54 – $20.54 | 1 |
| Inj recombin esperoct per iu HCPCS J7204 | not published | not published | $2.14 – $2.84 | 3 |
| Inj, releuko 1 mcg HCPCS Q5125 | not published | not published | $0.43 – $0.64 | 2 |
| Inj retacrit esrd on dialysi HCPCS Q5105 | not published | not published | $0.71 – $1.32 | 2 |
| Inj retro urethrocysto CPT 51610 | $122.19 | $187.98 | not published | 0 |
| Inj, rimabotulinumtoxinb HCPCS J0587 | not published | not published | $13.00 – $14.58 | 2 |
| Inj roctavian ml 2x10^13vc g HCPCS J1412 | not published | not published | $11,201.40 – $11,201.40 | 1 |
| Inj., rolapitant, 0.5 mg HCPCS J2797 | not published | not published | $0.85 – $0.85 | 1 |
| Inj romidepsin non-lyo 0.1mg HCPCS J9318 | not published | not published | $30.70 – $38.38 | 2 |
| Inj, rykindo, 0.5 mg HCPCS J2801 | not published | not published | $11.80 – $11.80 | 1 |
| Inj, sculptra, 0.5mg HCPCS Q2028 | not published | not published | $0.62 – $0.62 | 1 |
| Inj sebelipase alfa 1 mg HCPCS J2840 | not published | not published | $490.08 – $612.60 | 2 |
| Inj secretin synthetic human HCPCS J2850 | not published | not published | $31.50 – $39.38 | 2 |
| Inj secukinumab intrav 1mg HCPCS J3247 | $5.55 | $8.54 | $17.73 – $17.73 | 1 |
| Inj, sezaby, 1 mg HCPCS J2561 | not published | not published | $1.28 – $1.28 | 1 |
| Inj, spesolimab-sbzo, 1 mg HCPCS J1747 | not published | not published | $61.43 – $61.43 | 1 |
| Inj sulf hexa lipid microsph HCPCS Q9950 | not published | not published | $18.72 – $34.80 | 2 |
| Inj, susvimo 0.1 mg HCPCS J2779 | not published | not published | $79.74 – $96.00 | 2 |
| Inj, sutimlimab-jome, 10 mg HCPCS J1302 | not published | not published | $18.13 – $19.64 | 2 |
| Inj. tagraxofusp-erzs 10 mcg HCPCS J9269 | not published | not published | $338.53 – $370.95 | 2 |
| Inj, taliglucerace alfa 10 u HCPCS J3060 | not published | not published | $40.64 – $50.35 | 2 |
| Inj teclistamab cqyv 0.5 mg HCPCS J9380 | not published | not published | $32.42 – $32.42 | 1 |
| Inj tedizolid phosphate HCPCS J3090 | not published | not published | $1.80 – $2.02 | 2 |
| Inj teplizumab mzwv 5 mcg HCPCS J9381 | not published | not published | $37.31 – $37.31 | 1 |
| Inj. teprotumumab-trbw 10 mg HCPCS J3241 | $569.11 | $875.56 | $352.56 – $371.32 | 2 |
| Inj testostero enanthate 1mg HCPCS J3121 | not published | not published | $0.05 – $0.09 | 2 |
| Inj testosterone cypionate HCPCS J1071 | $0.11 | $0.17 | $0.03 – $0.07 | 2 |
| Inj theophylline per 40 mg HCPCS J2810 | not published | not published | $0.38 – $0.47 | 2 |
| Inj. tigecycline (accord) HCPCS J3244 | not published | not published | $2.40 – $3.00 | 2 |
| Inj., tildrakizumab, 1 mg HCPCS J3245 | not published | not published | $131.46 – $185.85 | 2 |
| Inj, tislelizumab-jsgr HCPCS J9329 | not published | not published | $52.46 – $52.46 | 1 |
| Inj tofersen intrathec 1 mg HCPCS J1304 | not published | not published | $155.34 – $155.34 | 1 |
| Inj travoprost intra impl HCPCS J7355 | not published | not published | $194.41 – $194.41 | 1 |
| Inj triamcinolone ace X-ray 1mg HCPCS J3304 | not published | not published | $18.01 – $22.89 | 2 |
| Inj triferic avnu 0.1mg iron HCPCS J1445 | not published | not published | $0.17 – $0.21 | 2 |
| Inj., triluron, 1 mg HCPCS J7332 | not published | not published | $10.28 – $29.34 | 2 |
| Inj., triptorelin X-ray 3.75 mg HCPCS J3316 | not published | not published | $3,506.04 – $3,638.17 | 2 |
| Inj, trivisc 1 mg HCPCS J7329 | not published | not published | $5.59 – $21.64 | 2 |
| Inj, uzedy, 1 mg HCPCS J2799 | not published | not published | $24.62 – $24.62 | 1 |
| Inj, vancomycin hcl (mylan) HCPCS J3371 | not published | not published | $6.31 – $9.65 | 2 |
| Inj, vancomycin hcl (xellia) HCPCS J3372 | not published | not published | $6.54 – $9.20 | 2 |
| Inj vasopressin (am reg) 1 u HCPCS J2599 | not published | not published | $1.33 – $1.33 | 1 |
| Inj, vasopressin (baxter) HCPCS J2601 | not published | not published | $3.50 – $3.50 | 1 |
| Inj velmanase alfa-tycv 1 mg HCPCS J0217 | not published | not published | $444.98 – $444.98 | 1 |
| Inj., vestronidase alfa-vjbk HCPCS J3397 | not published | not published | $260.74 – $298.32 | 2 |
| Inj. viltolarsen HCPCS J1427 | not published | not published | $54.14 – $67.68 | 2 |
| Inj. xembify, 100 mg HCPCS J1558 | not published | not published | $14.28 – $21.14 | 2 |
| Inj xipere 1 mg HCPCS J3299 | not published | not published | $48.23 – $55.00 | 2 |
| Inj., yutiq, 0.01 mg HCPCS J7314 | not published | not published | $524.57 – $593.20 | 2 |
| Inotuzumab ozogamicin 0.9 mg(0.25 mg/ml initial concentration) IV soln HCPCS J9229 | not published | not published | $2,658.13 – $2,807.50 | 2 |
| Inpatient consultation CPT 99251 | not published | not published | $30.61 – $30.61 | 1 |
| Insert cath pleura without image CPT 32556 | $4,688.19 | $7,212.60 | not published | 0 |
| Insert drug delivery implant CPT 11981 | $284.91 | $438.33 | not published | 0 |
| Insert intrauterine device iud CPT 58300 | $174.64 | $268.67 | not published | 0 |
| Insertion catheter bladder non indwelling CPT 51701 | $157.78 | $242.74 | not published | 0 |
| Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 | $1,477.11 | $2,272.48 | not published | 0 |
| Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 | $2,629.22 | $4,044.96 | not published | 0 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | $6,886.74 | $10,594.99 | not published | 0 |
| Insitu hybridization auto CPT 88367 | not published | not published | $179.38 – $179.38 | 1 |
| Insitu hybridization (fish) CPT 88366 | not published | not published | $179.38 – $179.38 | 1 |
| Insitu hybridization manual CPT 88368 | not published | not published | $179.38 – $179.38 | 1 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $226.30 | $348.15 | $179.38 – $179.38 | 1 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $290.37 | $446.73 | $179.38 – $179.38 | 1 |
| Ins picad w subq port 5yr> CPT 36571 | $70.06 | $107.78 | not published | 0 |
| Insti hexaminolevulinate hcl HCPCS A9589 | not published | not published | $1,450.80 – $1,450.80 | 1 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $1,475.90 | $2,270.61 | not published | 0 |
| Instill, bupivac and meloxic HCPCS C9088 | not published | not published | $0.73 – $0.80 | 2 |
| Inst tauro 1.35mg/hep 100u HCPCS J0911 | not published | not published | $8.00 – $8.00 | 1 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $4,679.33 | $7,198.97 | not published | 0 |
| Insulin for insulin pump use HCPCS J1817 | not published | not published | $2.49 – $16.48 | 2 |
| Insulin suppression panel CPT 80432 | not published | not published | $110.23 – $2,153.96 | 4 |
| Insulin tolerance panel CPT 80434 | not published | not published | $276.48 – $3,707.16 | 3 |
| Insulin tolerance panel CPT 80435 | not published | not published | $99.91 – $1,339.64 | 3 |
| Insulin total CPT 83525 | $63.75 | $98.07 | $11.09 – $148.66 | 4 |
| Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm HCPCS Q4114 | not published | not published | $2,156.33 – $2,156.33 | 1 |
| Integra meshed bil wound mat HCPCS C9363 | not published | not published | $65.21 – $65.21 | 1 |
| Interdental fixation CPT 21110 | $3,431.73 | $5,279.58 | not published | 0 |
| Interferon alfa-2a inj HCPCS J9213 | not published | not published | $40.75 – $40.75 | 1 |
| Interferon alfa-2b inj HCPCS J9214 | not published | not published | $29.50 – $36.88 | 2 |
| Interferon alfacon-1 inj HCPCS J9212 | not published | not published | $5.02 – $5.02 | 1 |
| Interferon alfa-n3 inj HCPCS J9215 | not published | not published | $28.91 – $36.14 | 2 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.